Ariz. Admin. Code § R9-16-203 - Initial Application for an Audiologist

A. Except as provided in subsection (B), an applicant for a speech-language pathologist license shall submit to the Department:

1. An application in a format provided by the Department that contains:

a. The applicant's name, home address, telephone number, and e-mail address;

b. The applicant's Social Security number, as required under A.R.S. §§ 25-320 and 25-502 ;

c. If applicable, the applicant's business address and telephone number;

d. If applicable, the name of the applicant's employer, including the employer's business address and telephone number;

e. Whether the applicant has ever been convicted of a felony or a misdemeanor involving moral turpitude in this or another state;

f. If the applicant has been convicted of a felony or a misdemeanor involving moral turpitude:

i. The date of the conviction,

ii. The state or jurisdiction of the conviction,

iii. An explanation of the crime of which the applicant was convicted, and

iv. The disposition of the case;

g. Whether the applicant is or has been licensed as a speech-language pathologist in another state or country;

h. Whether the applicant has had a license revoked or suspended by any state within the previous two years;

i. Whether the applicant is currently ineligible for licensing in any state because of a license revocation or suspension;

j. Whether a disciplinary action has been imposed by any state, territory, or district in this country for an act related to the applicant's speech-language pathologist license;

k. Whether the applicant agrees to allow the Department to submit supplemental requests for information under R9-16-209 ;

l. An attestation that the information submitted is true and accurate; and

m. The applicant's signature and date of signature;

2. If applicable, a list of all states and countries in which the applicant is or has been licensed as speech-language pathologist;

3. If a license for the applicant has been revoked or suspended by any state within the previous two years, documentation that includes:

a. The date of the revocation or suspension,

b. The state or jurisdiction of the revocation or suspension, and

c. An explanation of the revocation or suspension;

4. If the applicant is currently ineligible for licensing in any state because of a license revocation or suspension, documentation that includes:

a. The date of the ineligibility for licensing,

b. The state or jurisdiction of the ineligibility for licensing, and

c. An explanation of the ineligibility for licensing;

5. If the applicant has been disciplined by any state, territory, or district of this country for an act related to the applicant's speech-language pathologist license that is grounds for disciplinary action under Title 37, Chapter 17, documentation that includes:

a. The date of the disciplinary action;

b. The state or jurisdiction of the disciplinary action;

c. An explanation of the disciplinary action; and

d. Any other applicable documents, including a legal order or settlement agreement;

6. A copy of the applicant's:

a. U.S. passport, current or expired;

b. Birth certificate;

c. Naturalization documents; or

d. Documentation of legal resident alien status;

7. Documentation of the applicant's:

a. Official transcript issued to the applicant by an accredited college or university after the applicant's completion of a master's degree consistent with the standards of this state's universities;

b. Completion of a clinical practicum, as required in A.R.S. § 36-1940.01(A)(2)(b) ; and

c. One of the following:

i. Completion of clinical fellowship signed by the clinical fellowship supervisor as required in A.R.S. § 36-1940.01(A)(2)(c) ; or

ii. Completion of a CCC within three years before the date of the application;

8. Documentation:

a. Of the applicant's passing score on the ETSNESLP; or

b. That the applicant is eligible for a waiver, according to A.R.S. § 36-1940.02(B), from the examination requirements in A.R.S. § 36-1940.01 ; and

9. A nonrefundable $100 application fee.

B. An applicant for a speech-language pathologist license, limited to providing services to pupils under the authority of a local education agency or state-supported institution, shall submit:

1. An application in a format provided by the Department that contains requirements in subsections (A)(1) through (6) and (A)(9);

2. A copy of an employee agreement or employment contract, conditioned upon the applicant's receipt of a speech-language pathologist license, with a local education agency or a state-supported institution that includes the:

a. Applicant's name and Social Security number,

b. Name of the local education agency or state-supported institution,

c. Classification title of the applicant,

d. Work dates or projected work dates of the employment contract, and

e. Signatures of the applicant and the individual authorized by the governing board to represent the local education agency or state-supported institution; and

3. A copy of a temporary or regular certificate in speech and language therapy issued by the State Board of Education to the applicant.

C. The Department shall review an application packet for a license to practice as a speech-language pathologist according to R9-16-209 and Table 2.1.

A. In addition to complying with R9-16-202, an applicant for initial licensure as an audiologist shall submit to the Department the following:

1. A transcript or equivalent documentation issued to the applicant from an accredited college or university after the applicant's completion of a doctoral degree consistent with the standards of this state's universities, as required in A.R.S. § 36-1940(A)(2) or documentation of the applicant's current CCC.

2. Documentation of a passing grade on a ETSNEA or current CCC dated within three years before the date of application required in A.R.S. §§ 36-1902(E) and 36-1940(A)(3) or current license from other state.

3. Documentation of completing supervised clinical rotation consistent with the standards of this state's universities required in A.R.S. § 36-1940(B)(2) or current CCC.

4. Whether the applicant is applying to fit and dispense hearing aids.

5. If applicable, a list of all states and countries in which the applicant is or has been licensed as an audiologist or an audiologist to fit and dispense hearing aids.

B. In addition to complying with R9-16-202, an applicant for initial licensure as an audiologist licensed to fit and dispense hearing aids who was awarded a master's degree before December 31, 2007 shall submit to the Department the following:

1. A transcript or equivalent documentation issued to the applicant from an accredited college or university demonstrating the applicant's completion of a master's degree in audiology before December 31, 2007 or documentation of the applicant's current CCC;

2. Documentation of a passing grade on an ETSNEA or current CCC dated within three years before the date of application; and

3. Documentation of a passing grade obtained by the applicant on a written hearing aid dispenser examination as required in A.R.S. § 36-1940(C)(4).

Notes

Ariz. Admin. Code § R9-16-203

Former Section R9-16-203 repealed, new Section R9-16-203 adopted effective January 23, 1978 (Supp. 78-1). Repealed effective March 14, 1994 (Supp. 94-1). Adopted by final rulemaking at 5 A.A.R. 4359, effective October 28, 1999 (Supp. 99-4). Amended by final rulemaking at 10 A.A.R. 2063, effective July 3, 2004 (Supp. 04-2). New Section made by exempt rulemaking at 20 A.A.R. 1998, effective 7/1/2014. Adopted by final expedited rulemaking at 26 A.A.R. 816, effective 4/8/2020.